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Everyday Malpractice?

Dear Friend,

"Dear Dr Dave, My doctor has placed me statins. I asked him about taking your fish oil with them and he said he had, "No idea!" so I thought I would ask you. I know you cannot give medical advice over the email but could you render an opinion and is there any info on this?" Craig Geshin, Casper Wyoming

This is a fairly common situation.

The busy doc does not want to be bothered with questions he/she cannot answer immediately.

There are no "Fish Oil" reps in the office to offer biased drug company funded studies to sway the doctors' opinion with "education".

So can you or should you use Fish Oil with statin drugs like Zocor, Lipitor Pravachol etc?

The simple answer is "yes" especially if the person has a "mixed" lipid disorder.

In English that means that they don't just have a simple problem like their bad cholesterol is too high, but they have other problems too like low good HDL cholesterol of high triglycerides.

Also if you've already had a heart attack or a "coronary syndrome" which just means you have blockages didn't cause a heart attack yet you should in my opinion be on Fish Oil.

I personally think in the 2 situations described above that it is malpractice not to be on Fish Oil because their is strong data to support it.

In my practice I tried to get everyone on fish oil that had any type of unstable heart situation, or had already had a heart attack.

Of course it's pointless to wait!

While the medical community at large does not support the use of any supplements for most diseases their is good data to suggest that fish oil may also reduce the number of first heart attacks and decrease the overall damage as well.

We already know it decrease irregular heart beats that can also be fatal during any heart attack.

The main problem comes from the fixation with numbers.

As doctors we all like to have a simple easy measure of things that we can focus on.

The best sales job the drug companies ever did was to push the cholesterol level as a measure of heart disease.

If we apply the following scientific data which would be used to degrade the effects of any supplement suggested to be useful to a statin here's what we'd get. 1) Statins reduce cholesterol...true

2) In the general population lower cholesterols generally lead to less heart disease. True.... if there is adequate good cholesterol. Remember many of the statins do little to increase the good cholesterol and some actually decrease it!

3) since 1 and 2 are true, statins must lower the incidence of heart disease in the general population in large studies.

1,2, and 3 are....True true and unrelated. There is very little data to suggest that statins have and a significant impact on reducing heart disease since their introduction.

The true cost of these drugs in terms of paying for them and the side effects they cause is unknown.

We know for sure that Fish Oil works and that it is safe.

We have entire nations of people who suffer less heart disease, and cancer because of it in scientifically proven studies that even skeptics agree upon.

Yet it may be malpractice not to use a potentially deadly drug that costs our nation billions of dollars a year, but it is not malpractice not to recommend Fish Oil!

Don't wait for the law and medicine to catch up! Go to the site now and start your journey to better health!!!

All the Best from the King of Pharmaceutical Grade Fish Oil, Dr Dave

Imitators Beware! The BS meter is running!

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References:

Efficacy of n-3 polyunsaturated fatty acids after myocardial infarction: results of GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico.

Marchioli R, Schweiger C, Tavazzi L, Valagussa F.

Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico, Associazione Nazionale Medici Cardiologi Ospedalieri, Italy. marchioli@cmns.mnegri.it. strongly suggest that n-3 PUFA treatment should be considered a recommended new component of secondary prevention. The importance of this combined/additive effect is further suggested by the analyses of the interplay between diet and n-3 PUFA: There is an interesting direct correlation between size of the effect and "correctness" of background diets. It can be anticipated that a conceptual barrier must be overcome: A "dietary drug" should be added to "dietary advice," which remains fundamental to allow this statement to become true in clinical practice.

Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. INTERPRETATION: Dietary supplementation with n-3 PUFA led to a clinically important and statistically significant benefit. Vitamin E had no benefit. Its effects on fatal cardiovascular events require further exploration.

Pharmacoeconomics. 2001;19(4):411-20. Related Articles, Links

Cost-effectiveness analysis of n-3 polyunsaturated fatty acids (PUFA) after myocardial infarction: results from Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto (GISSI)-Prevenzione Trial.

Franzosi MG, Brunetti M, Marchioli R, Marfisi RM, Tognoni G, Valagussa F; GISSI-Prevenzione Investigators.

Department of Cardiovascular Research, Istituto di Richerche Farmacologiche Mario Negri, Milano, Italy. franzosi@marionegri.it
CONCLUSIONS: The cost effectiveness of long term treatment with n-3 PUFA is comparable with other drugs recently introduced in the routine care of secondary prevention after MI. Since the clinical benefit provided by n-3 PUFA is additive, this therapy should be added to the established routine practice, with additive costs.

: Arterioscler Thromb. 1993 Dec;13(12):1755-62. Related Articles, Links

Effect of pravastatin and omega-3 fatty acids on plasma lipids and lipoproteins in patients with combined hyperlipidemia.

Contacos C, Barter PJ, Sullivan DR.

Department of Clinical Biochemistry, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. Fundam Clin Pharmacol. 2004 Oct;18(5):581-92. Related Articles, Links

Fish oils in the care of coronary heart disease patients: a meta-analysis of randomized controlled trials.

Yzebe D, Lievre M. Five relevant outcomes, mortality from all causes, fatal and non-fatal MI, non-fatal stroke and angina, were measured. Data were synthesized using a fixed effect model. Ten RCTs with 14,727 patients were included. No significant heterogeneity was detected. Daily intake of omega-3 fatty acids for a mean duration of 37 months decreased all causes of mortality by 16% (relative risk 0.84, 95% confidence interval [0.76; 0.94]) and the incidence of death due to MI by 24% (0.76, [0.66; 0.88]).

Pharmacoeconomics. 2005;23(1):13-25. Related Articles, Links

Pharmacoeconomic impact of non-compliance with statins.

Peterson AM, McGhan WF.

Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Pennsylvania, USA. the studies were small and not designed as true pharmacoeconomic studies looking at the relationship between medication compliance and cost .The results of this review suggest that there needs to be further examination of the relationship between compliance with statins and cost effectiveness, and studies need to include compliance in their data collection and analysis. In other words even though statins are worth billions of dollars a year to drug companies, we don't really know what they are worth to patients who take them! Doc

: Health News. 2004 Nov;10(11):11. Related Articles, Links

Doubling Zocor dose fails to double its benefit. Whoops! Don't tell that to Merck!

N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials.

Bucher HC, Hengstler P, Schindler C, Meier G.

Institut fur Klinische Epidemiologie, Kantonsspital Basel, Basel, Switzerland. CONCLUSION: This meta-analysis suggests that dietary and non-dietary intake of n-3 polyunsaturated fatty acids reduces overall mortality, mortality due to myocardial infarction, and sudden death in patients with coronary heart disease.

Dave Woynarowski, M.D., CPT
The Nation's #1 Anti-Aging Physician

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